Healthcare Provider Details

I. General information

NPI: 1326221532
Provider Name (Legal Business Name): PINEVILLE INDEPENDENT SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W VIRGINIA AVE
PINEVILLE KY
40977-1321
US

IV. Provider business mailing address

401 W VIRGINIA AVE
PINEVILLE KY
40977-1321
US

V. Phone/Fax

Practice location:
  • Phone: 606-337-3412
  • Fax:
Mailing address:
  • Phone: 606-337-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number21007026002
License Number StateKY

VIII. Authorized Official

Name: MICHAEL WHITE
Title or Position: SUPERINTENDENT
Credential:
Phone: 606-337-5701